Provider Demographics
NPI:1811341878
Name:CLIFTON, STANLEY BERRICK III (DO)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:BERRICK
Last Name:CLIFTON
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 STARR FARM RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05408-1323
Mailing Address - Country:US
Mailing Address - Phone:369-183-4883
Mailing Address - Fax:
Practice Address - Street 1:48 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-8532
Practice Address - Country:US
Practice Address - Phone:336-918-3488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-15
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT032.0134093FCTY207R00000X
390200000X
NY324548207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program